Psycho-Babble Medication Thread 303137

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MAOIs v SSRIs v Benzos for Social Phobia

Posted by Zabadoo on January 20, 2004, at 8:30:53

There's been alot of talk on this board about how much more effective the MAOIs and Benzos are then SSRIs. Nardil and Klonopin, are especially popular amongst posters. So I was wondering if the following study, which states that all three groups are of equal effect, is just plain wrong?

Pharmacological treatment of social anxiety disorder: a meta-analysis.

Blanco C, Schneier FR, Schmidt A, Blanco-Jerez CR, Marshall RD, Sanchez-Lacay A, Liebowitz MR.

Department of Psychiatry of Columbia College of Physicians and Surgeons, Madrid, Spain. cb255@columbia.edu

Placebo-controlled trials have evaluated the efficacy of several medications in the treatment of social anxiety disorder but information regarding their relative efficacy is lacking. We compared the efficacy of medications systematically studied for the treatment of social anxiety disorder using meta-analytic techniques. The methodology included a database search of articles published between January 1980 and June 2001 and manual searches of bibliographies in published manuscripts. Trials were included if they reported outcome data on the Liebowitz Social Anxiety Scale (LSAS) or a categorical measure of responder status. Data were extracted independently by two authors. The Q statistic was used to assess homogeneity across trials. All analyses were conducted using intent-to-treat data. There was substantial heterogeneity across trials. The medications with largest effect sizes were phenelzine [effect size, 1.02; 95% Confidence Interval (CI), 0.52-1.52], clonazepam (effect size, 0.97; 95% CI, 0.49-1.45), gabapentin (effect size, 0.78; 95% CI, 0.29-1.27), brofaromine (effect size, 0.66; 95% CI, 0.38-0.94), and the selective serotonin reuptake inhibitors (SSRIs; effect size, 0.65; 95% CI, 0.50-0.81). There were no statistically significant differences between medications or medication groups. However, formal methods of interim monitoring adapted for meta-analyses suggested strongest evidence of efficacy for SSRIs and brofaromine. Several medications are efficacious for the treatment of social anxiety disorder. The stability of the SSRI effect size estimate in conjunction with other evidence for safety and tolerability and their ability to treat comorbid conditions supports the use of SSRIs as the first-line treatment. Direct comparisons of SSRIs vs. other promising medications deserve consideration. Copyright 2003 Wiley-Liss, Inc.

 

Re: MAOIs v SSRIs v Benzos for Social Phobia

Posted by gardenergirl on January 20, 2004, at 9:36:15

In reply to MAOIs v SSRIs v Benzos for Social Phobia, posted by Zabadoo on January 20, 2004, at 8:30:53

Zabadoo,
It's hard to say based on the selection of posters here on PB whether a specific study is right or wrong. Clinical studies are done under controlled conditions and have specific outcome measures. How each person reacts to and feels while on a specific med is different. It is a good idea to look at research, but also to use what works best for you.
Regards,
gg

 

Re: MAOIs v SSRIs v Benzos for Social Phobia

Posted by Kon on January 21, 2004, at 1:57:06

In reply to MAOIs v SSRIs v Benzos for Social Phobia, posted by Zabadoo on January 20, 2004, at 8:30:53

>So I was wondering if the following study, which states that all three groups are of equal effect, is just plain wrong?

There was no statistical difference but this review and another one (Federoff, 2001)did find a trend favouring benzos. In the full article, these authors write, "Our analysis found that clonazepam, based on a single study, had the largest mean effect size of all medications. The effect sizes of SSRIs and phenelzine were similar to each other and numerically (but not statistically) smaller than those of clonazepam".

In the end both of these group of authors still recommended SSRIs as first-line therapy for SAD primarily because of the dependency/withdrawl issue with benzos. The weakness with this argument is SSRIs seem to have a similar (if not worse)problem wrt withdrawl/dependency.

I asked my pdoc about this inconsistency. He agreed with much of the above. He even told me that he has never seen anyone with SAD not get some relief with some benzo. This was not the case with SSRIs where some patients did not respond at all to SSRIs. Despite these results in his patients he was still cautious in recommending long-term benzo use for SAD. He felt that long-term use can lead to depression in some patients. He also felt that benzos (especially short-acting ones like xanax) can sometimes lead to true "addiction" (i.e. drug-seeking behaviour)


 

Re: MAOIs v SSRIs v Benzos for Social Phobia

Posted by ann72 on January 21, 2004, at 7:49:17

In reply to Re: MAOIs v SSRIs v Benzos for Social Phobia, posted by Kon on January 21, 2004, at 1:57:06

Hello, Ive tried most ssri's for SP -the only one that worked was paxil -, but i had to stop taking it for the side effects. Nothing has worked the same. I asked my pdoc about MAOI's and she isnt familiar with them and doesnt want to mess with them. I have been taking benzo's for a few years and I do feel that I am addicted. Its scary. But she still keeps me on them.
Good luck to you.
Ann

 

Re: MAOIs v SSRIs v Benzos for Social Phobia » Kon

Posted by micro on January 22, 2004, at 8:51:05

In reply to Re: MAOIs v SSRIs v Benzos for Social Phobia, posted by Kon on January 21, 2004, at 1:57:06

> >So I was wondering if the following study, which states that all three groups are of equal effect, is just plain wrong?
>
> There was no statistical difference but this review and another one (Federoff, 2001)did find a trend favouring benzos. In the full article, these authors write, "Our analysis found that clonazepam, based on a single study, had the largest mean effect size of all medications. The effect sizes of SSRIs and phenelzine were similar to each other and numerically (but not statistically) smaller than those of clonazepam".
>
> In the end both of these group of authors still recommended SSRIs as first-line therapy for SAD primarily because of the dependency/withdrawl issue with benzos. The weakness with this argument is SSRIs seem to have a similar (if not worse)problem wrt withdrawl/dependency.
>
> I asked my pdoc about this inconsistency. He agreed with much of the above. He even told me that he has never seen anyone with SAD not get some relief with some benzo. This was not the case with SSRIs where some patients did not respond at all to SSRIs. Despite these results in his patients he was still cautious in recommending long-term benzo use for SAD. He felt that long-term use can lead to depression in some patients. He also felt that benzos (especially short-acting ones like xanax) can sometimes lead to true "addiction" (i.e. drug-seeking behaviour)
>
>
> Hello, That is an interesting article. Can I ask how many individuals were in the study and was it double blind ? What symtoms were they trying to target? Klonopin is not an antidepressant and is well known to actually precipitate or worsen depression in many people. Actually, benzo's of any kind can contribute to depressive symtoms.They are however, relatively safe and do help those individuals with anxiety symtoms. [Gorman] Thanks . Micro

P.S. What publication was this article excerpted from?

 

Re: MAOIs v SSRIs v Benzos for Social Phobia

Posted by Kon on January 22, 2004, at 11:16:36

In reply to Re: MAOIs v SSRIs v Benzos for Social Phobia » Kon, posted by micro on January 22, 2004, at 8:51:05

> Hello, That is an interesting article. Can I ask how many individuals were in the study and was it double blind ?

The Blanco et al. (2003)paper is a review paper of all SAD studies (and meta-analytic reviews)completed between years 1980-2002. Only studies that were double-blind and had a placebo were considered. The number of subjects in each study varies (from as low as 30 subjects to as high as 578). The authors relied heavily on meta-analytical reviews because few head-to-head comparisons of drugs have been done.

>What symtoms were they trying to target?

Social anxiety disorder symptoms.

> P.S. What publication was this article excerpted from?

Blanco et al., The evidence-based pharmacological treatment of social anxiety disorder. International J of Neuropsychopharmacology (2003), 6, 427-442.

 

Xanax XR,once daily lessens the abuse potential! (nm)

Posted by theo on January 22, 2004, at 13:00:05

In reply to Re: MAOIs v SSRIs v Benzos for Social Phobia, posted by Kon on January 21, 2004, at 1:57:06


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